Surgical treatment of morbid obesity increases likelihood of patients returning to work

Obese Medicaid patients who undergo Roux-en-Y gastric bypass surgery may be more likely to return to work than obese Medicaid patients who do not undergo the surgery, according to a report in the October issue of Archives of Surgery.

About 65 percent of adults in the U.S. are overweight and 5 percent are morbidly obese, having a body mass index (BMI) greater than 40, according to background information in the article. “Obesity is associated with a variety of diseases, including diabetes mellitus, hypertension, hyperlipidemia, degenerative arthritis, sleep apnea and left ventricular hypertrophy. Depression, social isolation and discrimination further compound the disability associated with morbid obesity,” the authors write. “As a result, morbid obesity results in dramatic increases in health care costs.”

Amy J. Wagner, M.D., and colleagues at Virginia Mason Medical Center, Seattle, studied 38 medically disabled patients receiving Medicaid who between 1997 and 2002 underwent Roux-en-Y gastric bypass performed by a single surgeon and compared these patients with 16 patients receiving Medicaid who were seen by the same surgeon, but did not undergo surgery. Patients' medical data were obtained by a review of their clinical charts and long-term follow-up telephone interviews.

Patients who underwent surgery had an average age of 48 and an average BMI of 58 before surgery and were followed for an average of 44 months, while those who did not undergo surgery had an average age of 51 and an average BMI of 54 at the beginning of the study and had an average of 32 months of follow-up. Average follow-up BMIs for the operative and non-operative groups were 36.2 and 52, respectively.

“The patients who underwent Roux-en-Y gastric bypass were more likely to return to work, with 14 (37 percent) working, compared with 1 (6 percent) of the non-operative control patients,” the authors write. “Return to work was more likely in patients who had resolution of comorbid conditions [co-occurring illnesses] after surgery.” Those who returned to work no longer required Medicaid funding.

“The practical implication of these findings is that the presence of reversible obesity-related comorbidities may be an appropriate prerequisite for approval of bariatric surgery in this population,” the authors conclude. “Surgical treatment of morbid obesity has a profound effect on patients' quality of life as evidenced by the sustained long-term weight loss, reversal of comorbidities, improved rating of quality of life and the patients' ability to return to the workforce.”

http://archsurg.ama-assn.org/